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Montana rates for HCPCS Q0164

Prochlorperazine maleate, 5 mg, oral, FDA-approved prescription antiemetic, for use as a complete therapeutic substitute for an IV antiemetic at the time of chemotherapy treatment, not to exceed a 48-hour dosage regimen

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.14 / $11.00 / $12.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.33 / $0.34 / $0.90
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.26 / $68,999.99 / $94,999.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.34 / $0.44 / $0.53
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.35 / $0.35 / $0.53
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.04 / $0.44 / $0.52
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.35 / $0.44 / $0.54
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.34 / $0.34 / $0.34